Tooth autotransplantation in the anterior maxilla and mandible: retrospective results in young patients

Autotransplantation of Premolars to the Anterior Maxilla: A Long-Term Retrospective Cohort Study of Survival, Success, Esthetic, and Patient-Reported Outcome With up to 38-Year Follow-Up

BACKGROUND/AIM

Autotransplantation is a well-documented procedure for replacing missing teeth in the anterior maxilla. This retrospective study aims to evaluate long-term survival rate, success rate as well as esthetics and patient-reported outcome of premolars autotransplanted to the anterior maxilla and secondarily to identify potential prognostic factors for survival, success, esthetic, and biological complications.

MATERIAL AND METHODS

One hundred and twenty-two patients with 153 transplants were assessed on survival rate and potential prognostic factors, while 50 patients with 61 autotransplanted premolars underwent clinical, radiographic, and esthetic assessment. Clinical and radiographic parameters were recorded. Esthetic outcomes were evaluated using a comprehensive score system comparing transplanted teeth to neighboring tooth. All patients filled in a questionnaire about the esthetic outcome of the treatment.

RESULTS

The survival rate of transplants after 16-38 years was 76%, with the majority showing no periodontal complications (95%). Radiographically, 46% of transplanted premolars showed no signs of pathosis. Ankylosis and inflammatory resorption were observed in 19% and 16%, respectively. Prognostic factors such as donor tooth type and root stage did not significantly affect transplant survival. Premolars transplanted at an immature stage had a significant lower risk of ankylosis, compared to more mature transplants. Esthetically, 72% of the transplants matched their neighboring teeth, and taking the biological success into consideration an overall success rate was 57.3%. In total, 71% of all patients were esthetically satisfied with their autotransplant, 18% were fairly satisfied, and 11% were dissatisfied.

CONCLUSIONS

The transplants demonstrated high survival rate, albeit with biological complications such as ankylosis and inflammatory root resorption. Developmental stage of the root at the time of transplantation had a significant influence on ankylosis of transplanted teeth. Esthetic outcomes were generally satisfactory, although challenges were noted with certain restoration types and donor tooth selections. Overall, the majority of patients expressed satisfaction with their autotransplanted teeth.

Nine-year Follow-up of Autotransplantation in the Maxillary Anterior Region: Replacing a Fused Incisor with a Supernumerary Tooth

The goal of tooth autotransplantation is to restore a missing tooth by using a functional tooth from the same patient. Although this procedure is gaining more recognition as a viable treatment option in dentistry, it is important to monitor and report long-term results. This case report presents the long-term follow-up of a fused maxillary central incisor that was extracted and replaced with a supernumerary tooth. Although the donor tooth displayed favorable characteristics, including an intact periodontal ligament and minimal extraoral time, which contributed to the success of the transplantation, it also presented certain disadvantages, such as having a fully developed root apex. Over a 9-year follow-up period, no clinical symptoms indicative of functional failure were observed. However, external cervical root resorption, first detected at the 6-year follow-up, progressed by the ninth year. Despite the lack of clinical symptoms, radiographic findings suggested that the root resorption was a significant concern. This case underscores the potential for long-term success of autotransplanted teeth, even in complex scenarios involving fused teeth. However, it also highlights the importance of thorough, long-term monitoring to detect complications such as root resorption. The findings suggest that, while autotransplantation can offer favorable outcomes, careful management and periodic evaluations are essential to ensure the longevity of the transplanted tooth.

Combined application of artificial bone powders and concentrated growth factor membranes on the autotransplantation of mature third molars: A 5-year retrospective case series

AIM

This study aimed to observe the efficacy and outcomes of the combined application of artificial bone powder and concentrated growth factor (CGF) membranes for tooth transplantation in cases with wide recipient sockets and small donor teeth.

MATERIAL AND METHODS

A total of 36 teeth from 36 patients with wide recipient sockets and small donor teeth were enrolled. Autogenous tooth transplantation was performed using bone powders and CGF membranes. After transplantation, the visual analog scale (VAS) score, Landry Wound Healing Index, probing depth (PD), mobility, and gray value of the alveolar bone around the transplanted teeth were measured, and a patient satisfaction questionnaire was administered. All patients underwent clinical and radiographic examinations during follow-up.

RESULTS

The VAS score of 16 (44.4%) cases after 1 week was 0, and 26 (72.2%) patients showed excellent gingival healing after 2-4 weeks. The PD of a few cases was deeper than 3 mm during the first month; however, returned to normal after 3 months. Although the majority of the transplanted teeth possessed mobility greater than grade I during the first month, the mobility gradually improved within 3 months. The gray value of the alveolar bone around the transplanted teeth, 1 year postoperatively showed no difference with pre-operation (p > .05). During the mean follow-up period of 42.7 months (range 20-72 months), 33 of the 36 transplanted teeth remained in situ without clinical or radiographic complications, with an overall success rate of 91.7%.

CONCLUSIONS

Although the PD and mobility of the transplanted teeth were not ideal during the early stages of healing, most of the transplanted teeth had good clinical outcomes. In cases with large recipient sites accompanied by small donor teeth, autotransplantation of teeth using artificial bone powder combined with CGF membranes is a viable option and can lead to optimistic results with favorable success rates.

An evaluation of 910 premolars transplanted in the anterior region-A retrospective analysis of survival, success, and complications

AIM

The aim this retrospective analysis was to evaluate the survival, success and possible complications of transplanted premolars to the anterior region subdivided in development stage and patient's age.

MATERIALS AND METHODS

The material comprised patients that underwent a tooth transplantation between April 2004 and December 2021. A total of 910 premolars were transplanted in 707 patients. Tooth mobility, oral hygiene, and periodontal parameters were clinically evaluated. Standardized radiographs were used to evaluate pulpal and periodontal healing and root formation. The cumulative survival rate was calculated using the Kaplan-Meier method.

RESULTS

The data were subdivided in three groups based on the stage of root development and patient's age. The average age at surgery was 16 years. The main indication for transplantation was trauma, followed by agenesis and other indications. Two premolars were lost during the whole observation period. The overall survival and success in the immature premolars group after an observation period of 10 years was 99.8%. The 10-year survival and success rate when fully developed premolars were transplanted in the anterior region in adolescents were 100% and 96.3%, respectively. In adults, the 10-year survival and success rate were 87.5%.

CONCLUSION

Transplantation of premolars with developing and fully developed roots to the anterior region in children, adolescents, and adults is a predictable treatment modality.

Anterior tooth autotransplantation: a case series

Tooth autotransplantation is the technique of transplanting embedded, impacted or erupted teeth from one site into another in the same individual. It is relatively common for the anterior segment of the mouth to be affected by traumatic tooth injuries, impacted and/or congenitally missing permanent teeth. Autotransplantation of teeth into the anterior dental arch can provide unrivalled biological solutions when such issues arise in this critical aesthetic zone, particularly for adolescent patients. The combination of meticulous pre-surgical assessment, synergistic interdisciplinary collaboration and carefully performed anterior tooth autotransplantation has been demonstrated to achieve impressive outcomes, with respect to both transplant survival and clinical success. © 2023 Australian Dental Association.

Tooth autotransplantation: An umbrella review

Tooth autotransplantation is a versatile procedure with several clinical applications among patients across different age groups. The success of this procedure depends on multiple factors. Despite the wealth of studies available, no single primary study or systematic review is able to report on every factor affecting the outcomes of autotransplantation. The aims of this umbrella review were to evaluate treatment-related and patient-related outcomes of autotransplantation and to assess the pre-, peri- or post-operative factors that could affect these. An umbrella review was conducted according to the PRISMA statement. A literature search of five databases was performed up to 25 September 2022. Systematic Reviews (SR) with and without meta-analysis evaluating autotransplantation were included. Calibration among reviewers was carried out prior to study selection, data extraction and Risk of Bias (RoB) assessment. Study overlap was calculated using corrected covered area. Meta-meta-analysis (MMA) was performed for suitable SRs. The AMSTAR 2 critical appraisal tool was used to evaluate the quality of evidence. Seventeen SRs met the inclusion criteria. Only two SRs were suitable for conduct of MMA on autotransplantation of open apex teeth. The 5-year and 10-year survival rates were >95%. A narrative summary on factors that could affect autotransplantation outcomes and comparisons of autotransplantation to other treatment options were reported. Five SRs were rated as 'low quality' and 12 SRs were rated as 'critically low quality' in the AMSTAR 2 RoB assessment. In order to facilitate a more homogenous pool of data for subsequent meta-analysis, an Autotransplantation Outcome Index was also proposed to standardise the definition of outcomes. Autotransplantation of teeth with open apices have a high survival rate. Future studies should standardise the reporting of clinical and radiographic findings, as well as the definition of outcomes.

What Are the Complications, Success and Survival Rates for Autotransplanted Teeth? An Overview of Systematic Reviews and Metanalyses

Background: Autotransplantation is the surgical repositioning of a tooth within the same patient. It can be thought of as the controlled avulsion and re-implantation of a tooth and can be a viable alternative to other dental rehabilitation options. This review aimed to evaluate the survival rate (SR), major complications such as ankylosis rate (AR) and infection-related root resorption (RR), and overall success and failure rate (FR) in autotransplanted teeth. Methods: Six databases were accessed up to January 2021 to obtain all systematic reviews and meta-analyses (SRs and MAs). Study selection: After title and abstract reading, data extraction was performed from eligible SRs. The methodological quality was calculated for the included SRs using the risk of bias in systematic reviews (ROBIS) tool. Results: Six SRs were included in this review. The overall failure rate ranged from as low as 2.0% to 10.32%. The 1-year survival was very high (97.4–98.0%). The 5-year survival rate ranged from 81 to 98.2%. Major complications of AR ranged from 1.2 to 6.2%, and RR ranged from 2.1 to 10.4%. Conclusion: The overall findings from these SR and MA are promising; however, all the SRs include only single-arm prospective or retrospective studies, the SRs are of overall low methodological quality, and for the heterogeneity of the included SRs, well-designed comparative studies with a long-term follow-up are recommended.

Autotransplantation of teeth with incomplete root formation: systematic review and meta-analysis

OBJECTIVES

To determine the survival of intentional autotransplantation of developing teeth.

MATERIAL AND METHODS

An electronic search was carried out in the MEDLINE database, Web of Science, and Cochrane Library. The criteria used are the ones described in the PRISMA Declaration. The following MeSH terms were used: ("tooth" [MeSH Terms] OR "tooth" [All Fields]) AND ("transplantation, autologous" [MeSH Terms] OR ("transplantation" [All Fields] AND "autologous" [All Fields]) OR "autologous transplantation" [All Fields] OR "autotransplantation" [All Fields]) AND ("humans" [MeSH Terms]. Randomised clinical trials and prospective and retrospective clinical studies were included.

RESULTS

The meta-analytic study of overall survival included a total of 14 studies, yielding an overall survival rate of 97.9%. In studies with 1-year follow-ups, survival was 98%. The resulting 2-year follow-up rate was 97%, while the 5- and 10-year survival rates were 95.9% and 96.9%, respectively.

CONCLUSIONS

The autotransplantation technique performed in a single-phase and on teeth that have not completed their development is a predictable technique, with a described survival rate at a 2-year follow-up of more than 97%.

CLINICAL RELEVANCE

The technique of dental autotransplantation is considered an important resource for the resolution and rehabilitation of tooth loss in patients, especially in those who are still in a growth period. Moreover, this technique has a low complication rate and a 10-year survival rate of 96.9%. It should therefore be considered a safe and reliable procedure.

A retrospective analysis of autotransplanted teeth including an evaluation of a novel surgical technique

OBJECTIVES

To assess survival rates and frequency of complications for immature and mature autotransplanted teeth after at least 1 year in function.

MATERIALS AND METHODS

All consecutive patients who had undergone tooth autotransplantation between 2000 and 2018 were invited to a clinical and radiographic follow-up examination. First, survival rates were calculated on the basis of a phone inquiry. A clinical follow-up examination allowed for the calculation of the success rate, i.e., absence of any potentially adverse clinical and radiographic findings of the autotransplanted teeth. Moreover, the effect of demographic, dental, and surgical variables on survival/success was analyzed statistically.

RESULTS

Thirty-eight teeth in 35 patients were transplanted during the study period. Three teeth in 3 patients were excluded due to missing records. All other patients were successfully contacted and interviewed by phone. Out of these 35 transplants, 32 were still in function, and 3 had been extracted, yielding a 91.4% survival probability after a median follow-up of 3.4 years. Of the 32 teeth qualifying for the success analysis, 20 (62.5%) showed absence of potentially adverse findings, while 3 (9.4%) required root canal treatment (RCT). Out of the 9 mature, root-end resected transplants, 4 exhibited ongoing pulp canal obliteration, all with a single root canal. Postoperative and potentially adverse findings or failures were found more frequently in the group of mature transplants (55.6%) than immature transplants (30.4%) and for molars (72.7%) than premolars (17.6%) or canines (25%). None of the potential predictors had a statistically significant effect on survival or success.

CONCLUSION

Autotransplanted teeth yielded a satisfying midterm survival rate regardless of their stage of development. An additional, extraoral root-end resection of mature transplants may lead to rates of revascularization and postoperative pulp canal obliteration higher than the data reported on unmodified mature transplants.

CLINICAL RELEVANCE

Extraoral root-end resection of mature teeth shows promising outcomes for transplants especially with a single root canal and uncomplicated root morphology.

Success, Survival Rate, and Soft Tissue Esthetic of Tooth Autotransplantation

INTRODUCTION

The aim of this retrospective study was to assess the success, survival rate, and soft tissue esthetic of autotransplanted teeth.

METHODS

This study included patients with at least 1 tooth autotransplanted to the maxilla during childhood or adolescence. The autotransplantation technique included the removal of an immature tooth from a donor site and its placement in the maxilla as a replacement for a missing or extremely compromised tooth. The cases were properly restored to ensure function and esthetic. To be considered successful, the tooth should be asymptomatic at the time of assessment, no pain to palpation and percussion, have no signs of apical periodontitis or a sinus tract, have a periodontal probe ≤3, and have an absence of root resorption and development of at least 70% of the normal root. The esthetic evaluation of the soft tissue was based on the pink esthetic score and graded as very unsatisfactory, unsatisfactory, poor, fair, good, or excellent. Data were statistically analyzed at a significance level of 5%.

RESULTS

Thirty-five patients (23 males and 12 females) had 43 anterior teeth replaced, including 42 central incisors and 1 lateral incisor. The follow-up period ranged from 1-25 years. In regard to success and the survival rate, 43 teeth were assessed; 34 cases (79.07%) were considered successful and 9 (20.93%) unsuccessful. Only 1 tooth was lost, and 42 teeth remained functional (survival rate = 97.67%). In regard to the esthetic, 40 teeth could be assessed and were considered as excellent (30%), good (35%), fair (27.5%), and poor (7.5%); there were no reports of unsatisfactory or very unsatisfactory cases.

CONCLUSIONS

Tooth autotransplantation can be considered a valid procedure to replace lost teeth in the maxilla, presenting high survival and success rates. The overall esthetic of the patients was considered as satisfactory.

Autologous transplant third mandibular molar in post extraction socket. Case report

Dental transplantation is a surgical alternative, which consists of transplanting a tooth from one alveolus to another in the same patient, very useful when replacing lost dental organs in young patients, with a high success rate. Present advantages helpful for patients providing a vital, proprioceptive and excellent aesthetic rehabilitation, without altering adjacent teeth, additionally represents an alternative cheaper. The purpose of this case report is to show clinical sequence about surgical approach for dental autotransplantation from lower third molar on alveolus after extraction of right lower first molar, carried out without endodontic treatment. Female patient case of 15 years old with a diagnosis of extensive caries not restorable in 46 is presented. It is decided through an interdisciplinary board to carry out, treatment with an autologous transplant of right lower third molar in socket post-extraction of first lower molar from the same hemiarchate, post-surgical controls are performed for up to one year. Dental transplantation is an excellent treatment option when it comes to replacing missing teeth, since it offers multiple functional and aesthetic advantages, mainly in children and young adults.

Autotransplantation and Orthodontic Treatment after Maxillary Central Incisor Region Trauma: A 13-Year Follow-Up Case Report Study

The anterior maxilla is the most prone region to the trauma during childhood, and tooth loss sometimes happens due to trauma. Replacing the missing teeth has always been one of the dentists' challenges in children and adolescents, since their dentofacial growth is not complete. Autotransplantation of mandibular premolars with two-thirds or three-quarters of root formation provides the best prognosis for the tooth survival. This case report describes the management of a 10-year-old boy suffering a severe dental injury who received the autotransplantation of the premolars from mandible to restore the space caused by trauma in maxillary central incisor region and a 13-year follow-up of the autotransplantation.

Autotransplantation of a Premolar with Incipient Root Development, an 18-Year Follow-Up

In young patients, premature tooth loss in the anterior maxilla after trauma is challenging for the patient and the dental professional, with serious implications from aesthetic and functional points of view, as well as from a craniofacial growth aspect perspective. Premolars autotransplanted into the maxillary anterior region have been shown to be a biological alternative in this situation. This report describes the clinical management of a case of premature loss of a maxillary central incisor after traumatic injury. A mandibular premolar at the stage of initial root development was transplanted into the alveolar socket of the lost incisor. After 18 years, the transplanted tooth remained responsive to pulp sensibility tests and the periradicular bone and soft tissues were within normal limits. Autotransplantation of premolar teeth into the maxilla could be considered an excellent treatment choice with many biological advantages over implants or fixed dentures as long as proper case selection is followed.